Spence R K, Dafoe D C, Rabin G, Grossman R A, Naji A, Barker C F, Perloff L J
Arch Surg. 1983 Mar;118(3):356-9. doi: 10.1001/archsurg.1983.01390030086014.
Primary mycobacterial infections developed in five of 565 patients who had transplants during a 15-year period. All had negative PPDs and normal chest roentgenograms; none had tuberculosis before transplantation. Atypical mycobacteria were cultured in three of five infections. All were treated with a multiple-drug regimen, including isoniazid, rifampin, ethambutol, and streptomycin sulfate. In four of five patients, there were serious drug-related complications. No major initial alteration of immunosuppressive therapy was necessary in any of the patients. During the study, a treatment policy was followed that included one year of isoniazid treatment of all recipients with a positive PPD, history of tuberculosis, chest x-ray film suggestive of tuberculosis, or PPD-positive donor. An additional 14 transplant recipients were treated in accordance with this policy without complications or subsequent mycobacterial infections (32-month average follow-up). Despite the low incidence of mycobacterial infection in this series, the potential lethality and morbidity mandate constant vigilance.
在15年期间接受移植的565例患者中，有5例发生了原发性分枝杆菌感染。所有患者结核菌素试验（PPD）均为阴性，胸部X线片正常；移植前均无结核病。5例感染中有3例培养出非典型分枝杆菌。所有患者均接受了包括异烟肼、利福平、乙胺丁醇和硫酸链霉素在内的多药联合治疗。5例患者中有4例出现了严重的药物相关并发症。所有患者均无需对免疫抑制治疗进行重大初始调整。在研究期间，遵循了一项治疗策略，即对所有PPD阳性、有结核病史、胸部X线片提示结核病或PPD阳性供体的受者进行为期一年的异烟肼治疗。另外14例移植受者按照该策略进行治疗，无并发症或随后的分枝杆菌感染（平均随访32个月）。尽管该系列中分枝杆菌感染的发生率较低，但潜在的致死率和发病率要求持续保持警惕。
